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在急性缺血性中风中进行血栓切除术后,强化与传统的血压控制:系统性审查和元分析
Sherief Ghozy1,2, Ali Mortezaei2, Mohamed Elfil3
1Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota.
JAMA network open
|February 22, 2024
概括
在急性缺血性中风的内血管血栓切除术后,强化降低血压不会改善结果,可能会增加风险. 建议在术后采取保守的血压管理方法.
科学领域:
- 神经学 神经学
- 干预心脏病学 干预心脏病学
- 关键护理医学 关键护理医学
背景情况:
- 内血管血栓切除术 (EVT) 是急性缺血性中风 (AIS) 的标准治疗方法,由大血管封闭 (LVO) 引起.
- 在EVT之后,最佳的血压 (BP) 控制仍然是争论的主题.
- 这项研究评估了不同缩血压目标对EVT后患者结果的影响.
研究的目的:
- 评估不同缩血压目标后EVT和患者结果之间的关联.
- 评估强化血压控制与常规血压控制对接受EVT的AIS患者功能独立,死亡率和并发症的影响.
主要方法:
- 进行了随机临床试验的系统审查和元分析.
- 搜索的数据库包括PubMed,Embase,科学网,Scopus和Cochrane图书馆,截至2023年9月8日.
- 来自4项涉及1571名患者的试验的数据使用随机效应元分析进行了聚合.
主要成果:
- 在密集血压对照组 (RR,0.81;95% CI,0.67-0.98) 观察到功能独立率较低.
- 两组之间在90天死亡率,症状性内出血或低血压事件方面没有发现显著差异.
- 对于功能独立结果,注意到最小的异质性.
结论:
- 强化EVT后的BP降低似乎没有提供好处,可能会增加风险.
- 目前的证据表明,在临床实践中,一种保守的BP管理策略是最受欢迎的.
- 通过正在进行的试验进行进一步的研究是有必要的,以确定最佳的BP目标.
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